Monday, January 9, 2012

Is DHEA the Next Wonder Drug for Menopause?

Many of the currently menopausal women in the United States came of age during the “Swinging Sixties.” Spurred on by very reliable contraceptives, the “sexual revolution,” and women’s right to have a satisfying sexual life, these women are less likely than their grandmothers to go off quietly into sexual retirement. Aging men with erectile problems have had several prescriptions drugs to enhance their sexual experience. Women have no FDA-approved drug to improve their sexual outcomes. Here at Web MD, we recently posted a news story about the use of an over-the-counter hormone called DHEA, which was said to “ease menopausal symptoms and improve women’s sex lives.” When that same release showed up on the start page of my computer it seemed time to investigate these claims.

Let’s try and answer these important questions:

Does DHEA improve sexual function?

Is over-the-counter DHEA safe?

What is the future for DHEA?

Does DHEA improve sexual function?

According to the just-published report from Genazzani and colleagues in Italy, it does. They state that a daily dose of a 10 mg DHEA pill worked as well as two different types of standard hormone therapy (tibolone 2.5 mg vs estradiol 1mg with dihydrogesterone 5 mg) in improving sexual function and frequency of intercourse compared to women who received nonhormonal treatment.

However, there have been other studies which do not suggest that DHEA works any better than a placebo pill. In one year-long study, 93 women with low desire were randomly assigned to take a sugar pill or DHEA 50 mg (five times more DHEA than the current study). Of the 85 women who were evaluated on satisfying sexual events and the Sabbatsberg Sexual Self-Rating Scale, the DHEA did not work any better than the sugar pill.

In an excellent review of DHEA use in postmenopausal women, the authors evaluated, then summarized the results of key studies up through 2010. They acknowledged that studies which did a single blood test for DHEA levels and a one-time questionnaire about sexual function seemed to suggest that low libido was linked to lower DHEA. However, when DHEA or a placebo/sugar pill was randomly given to study women, there was no significant benefit for DHEA pills.

Let’s say you are a postmenopausal woman and you decide to try DHEA. You have read that women’s natural DHEA levels peak while in our twenties—and most of us do not complain about libido in our twenties. So the next question would be: are DHEA pills safe?

Is over-the-counter DHEA safe?

Unlike in Europe, DHEA is available in the U.S. without a prescription. It is an active hormone, naturally produced by our adrenal glands. Our body will convert the DHEA to both estrogens (female hormones) and androgens (male hormones). I mention this as a breast cancer survivor once asked if she could take DHEA. I quoted a study by Genazzani (yes, the same scientist with the new study) published nine years ago in which postmenopausal women were given DHEA 25 mg pills for a year. Their blood levels of estradiol were 90 picograms. This is a level found in young, ovulating women.

Surprisingly, no undue stimulation of the lining of the uterus has been found in studies where menopausal women were given DHEA 25 mg or 50 mg. However, the women were followed for only 12 months. So we still do not know about long-term safety at such doses. If I had a patient using long-term DHEA I would want to be sure that their uterine lining was not being stimulated by newly created estrogen. This could be done with an ultrasound measurement of lining thickness.

What is the future for DHEA?

As noted above, DHEA can produce estrogen effects in the body. Estrogen has a very well demonstrated positive effect on sexual function. It can improve lubrication and quality of vaginal tissues. After menopause, when blood estrogen/estradiol levels drop below 20 picograms or less, vaginal dryness (“vaginal atrophy”) can make intercourse painful. In a “twenty- something” vaginal tissues will be 20-30 cells thick. After menopause when estrogen levels are low, vaginal tissues may be only 6-8 cells thick.

Currently, low-dose DHEA is undergoing testing to be an FDA-approved treatment for vaginal atrophy. Among the vaginal doses studied, blood levels of estrogen and androgens remained in the normal, postmenopausal range. Interestingly, the use of the 1% vaginal DHEA product seemed to yield not just improvements in lubrication/arousal/vaginal dryness, but also a slight stated improvement in orgasm.

The evidence continues to be mixed as to whether DHEA is the long awaited “wonder drug” for menopause. There can be so many variables involved in low libido, it is hard to believe that a single treatment will work uniformly well for all women. If readers are considering using DHEA pills I would strongly urge you to let your healthcare provider know. It is not FDA approved, so the jury is still out.

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Margaret Polaneczky, MD

Margaret Polaneczky, MD is a board certified obstetrician-gynecologist and Associate Professor of Clinical Obstetrics and Gynecology at Weill Medical College of Cornell University in New York City. She is the author of The Blog that Ate Manhattan, a blog that combines her love of food, medicine and New York City.

Heather Rupe, DO

Heather Rupe, DO, is a board-certified OB/GYN in private practice in Franklin, TN, and serves as the vice chief of staff at Williamson Medical Center. She is the co-author of The Pregnancy Companion: A Faith-Filled Guide for Your Journey to Motherhood and The Baby Companion: A Faith-Filled Guide for Your Journey through Baby’s First Year.

Arefa Cassoobhoy, MD, MPH

Arefa Cassoobhoy, MD, MPH is a board-certified internal medicine doctor and a WebMD Medical Editor. She is on the team that makes sure all WebMD content is medically correct, current and understandable. She sees patients at the Women’s Wellness Clinic at the Atlanta Veterans Affairs Medical Center.